Influence of different relationships of bystanders to out-of-hospital cardiac arrest patients on the effectiveness of dispatcher-assisted CPR

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) significantly improves CPR performance by bystanders, increasing the survival of patients. However, emotional stress among family members witnessing out-of-hospital cardiac arrest (OHCA) may hinder their ability to effectively perform CPR, leading to delayed and poorer quality CPR. The influence of the relationships of callers to patients (i.e., family members, friends, and strangers) on DA-CPR outcomes remains insufficiently explored.

MATERIALS AND METHODS: This retrospective observational study analyzed the data of nontraumatic OHCA cases in Taoyuan City, Taiwan, from August 2021 to January 2023. Data from the registries of emergency medical services and emergency call recordings were examined. Relationships of callers to patients, emotional barriers, time metrics (time to CPR instruction initiation and first compression), and barriers to DA-CPR success were evaluated. Associations between callers' relationships to patients and DA-CPR performance were analyzed through multivariable logistic regression.

RESULTS: Among 1,036 nontraumatic OHCA cases, 59.3% of callers were family members, 13.6% were friends, and 27.1% were strangers. Cardiac arrest recognition rates were lower for family members (68.2%) than for strangers (84.0%) (p < 0.001). Time to CPR instruction (117 vs. 91 s, p = 0.034) and the first chest compression (200 vs. 179 s, p = 0.018) were significantly delayed for family members. For family members, emotional stress and protocol nonadherence were the main barriers to CPR performance.

CONCLUSION: The relationship of the caller to the patient significantly influences DA-CPR outcomes. Family members experience increased emotional stress, resulting in delays and decreased recognition rates. Targeted family-centered education and enhanced dispatcher support are essential to address these challenges and improve the survival outcomes of patients with OHCA.